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Tuesday Tidbits: International Day of the Midwife

IMG_4848Today is International Day of the Midwife and I find myself reflecting on the many midwives I have known and the incredibly diversity and gifts of the women who join this profession. In addition to the midwives I had for prenatal and postpartum care for each of my births, I’ve been privileged to know many midwives on the state and national level through our shared interest in maternity care activism and birth rights. With my first baby, I had prenatal and birth care with a family practice physician and a CPM. The CPM was gray-haired, pretty, soft-spoken and wryly witty and pretty much exactly what you picture a stereotypical midwife looking like! My prenatal care with this team was excellent, birth care so-so (I didn’t need much), but my postpartum care left a lot to be desired and I felt very cast adrift after the birth. I became very embroiled with midwifery activism and birth work after this birth and as a result my experiences with all subsequent midwives has been an interesting blend of collegial + consumer. My first birth was the only one for which I was consumer only. Though I’m not a midwife myself, my subsequent experiences all involved being a sister birthworker AND client, rather than solely a client. This has both benefits and disadvantages.

My midwife with my second baby was amazing. I loved her so much and I have felt a gap in every pregnancy following that I was not able to have her as a midwife again. She was gentle and caring and passionate and inspiring and wonderful. Cute and upbeat, full-figured, and intelligent, she had a soft and reassuring presence and gave wonderful hugs! We became good friends and she was a very important part of my life. My prenatal care and birth care with her was excellent. She was also helpful with postpartum care, but I don’t think I “allowed” her to be as helpful as she could have been because I couldn’t allow myself to be as vulnerable and needy as I actually felt.

When I was pregnant with my third baby, my much-loved midwife had moved away and found myself at a loss for who to choose for pregnancy and birth care. This baby died early in my second trimester and I found myself calling on the sisterhood of midwives for help when I desperately needed it. From the very busy midwife who talked to me kindly and patiently when I was freaking out over a retained placenta, to the Mennonite midwife who helped me from the road as she was driving to another state and connected me to yet another midwife several hours away who drove in to town to meet and help me when I was very scared and alone, it was during this experience that I realized very viscerally how much we need midwives in our lives. When I was pregnant again, I decided to choose the Mennonite midwife for my prenatal care and immediate postpartum care. She is a very capable and determined and intelligent midwife, but I felt an unbridgeable gap between us spiritually speaking and so was never able to fully connect with her emotionally. She embodied the gray-haired, no-nonsense “granny midwife” archetype. She provided great prenatal care and was very respectful of my wish for immediate postpartum care, but an unassisted birth. Postpartum follow-up care was limited due to snowstorms.

With my last baby, I felt a powerful need to feel taken care of again. I really needed to have some set aside time, Mollyblessingway 027space, and energy that was just focused on me and my baby. I knew that I needed a midwife! While I could have used the same midwife as with the baby before, this time it was important to me to develop the emotional connection I had with my second midwife—I needed a midwife with whom I could feel “safe” with all of me, instead of feeling like I had to hide my goddess sculptures when she came over! 😉 It took some work, but I was able to find that. With this experience, I came to accept that the blur between colleague-consumer is my reality and I will never re-capture the feeling of being client only and being completely focused on in that respect, because I’m simply not just a client only. That’s okay. This midwife has long brown hair, wears lots of skirts and had the hippie-ish midwife feel I was craving. She is funny and talkative and connected to the roots of what midwifery is all about. I was safe with her in the way I needed. I really appreciated the midwife’s prenatal care (and the opportunity to focus on my pregnancy and baby), her respect of my wish for immediate postpartum care rather than birth care, and her postpartum follow-up care. I felt like this midwife offered the most complete postpartum care of all of my birth experiences.

I’ve mentioned before that the only vaginal exam I had during six pregnancies was at ten centimeters dilated when I went to the birth center to push out my baby (I also had to have one for a manual clot extraction following his birth and one for help removing the placenta after my miscarriage-birth of my third baby). This is totally cool with me. Somehow I’ve managed to labor and birth four full-term babies without ever knowing how dilated I am in labor! So, I loved reading this article about the pointlessness of vaginal exams in labor and the cultural attachment, even in midwifery circles, to cervix-focused childbirth:

“…There is also reluctance to change hospital policies, underpinned by a need to maintain cultural norms. The Cochrane review on the use of partograms on the one hand states that they cannot be recommended for use during ‘standard labour care’, and on the other hand states: “Given the fact that the partogram is currently in widespread use and generally accepted, it appears reasonable, until stronger evidence is available, that partogram use should be locally determined.” Once again, an intervention implemented without evidence requires ‘strong’ evidence before it is removed. The reality is that we are unlikely to get what is considered ‘strong evidence’ (ie. randomised controlled trials) due to research ethics and the culture of maternity systems. Guidelines for care in labour continue to advocate ‘4 hourly VEs’ and reference each other rather than any actual research to support this (NICE, Queensland Health). Interesting whilst Queensland Health guidelines recommend 4 hourly VEs, their parent information leaflet states: “While a VE can provide information about how a woman has progressed so far in labour, it cannot predict how much longer you will be in labour…” and that there are “…other factors such as the strength, duration and length of contractions as well as a woman’s behaviour and wellbeing that can indicate progress in labour”. Which begs the question ‘why bother doing a VE’?

The cervical-centric discourse is so embedded that it is evident everywhere. Despite telling women to ‘trust themselves’ and ‘listen to their body’, midwives define women’s labours in centimetres “She’s not in labour, she’s only 2cm dilated”. We do this despite having many experiences of cervixes misleading us ie. being only 2cm and suddenly a baby appears, or being 9cm and no baby for hours. Women’s birth stories are often peppered with cervical measurements “I was 8cm by the time I got to the hospital”. Even women choosing birth outside of the mainstream maternity system are not immune to the cervical-centric discourse. Regardless of previous knowledge and beliefs, once in labour women often revert to cultural norms (Machin & Scamell 1997). Women want to know their labour is progressing and there is a deep subconscious belief that the cervix can provide the answer. Most of the VEs I have carried out in recent years have been at the insistence of labouring women – women who know that their cervix is not a good indicator of ‘where they are at’ but still need that number. One woman even said “I know it doesn’t mean anything but I want you to do it”. Of course, her cervix was still fat and obvious (I didn’t estimate dilatation)… her baby was born within an hour…”

Vaginal examinations: a symptom of a cervical-centric birth culture | MidwifeThinking

I also read this article about the now late, great midwife and activist, Sheila Kitzinger and how she connected her birthwork to feminism (as do I). I despise the article’s title, but it is still worth a read!

…In the Seventies, I was viewed as a radical for saying that birth was being depersonalised and treated as if it were a pathological event, rather than a normal life process.

To my surprise, it wasn’t just obstetricians who dismissed what I had to say. I also found myself in conflict with feminists, who saw birth in very simplistic terms.

Why? Because they claimed it was every woman’s right to give birth painlessly.

An article in Spare Rib, the radical campaigning feminist magazine, went further.

Without any evidence, the authors asserted: ‘Undoubtedly, hospitals, with all their faults, are the safest places in which to give birth. For this reason, we think we should press for improvements in hospitals rather than support a move to more home confinements.’

I was appalled at how my sister-feminists could fail to support woman-centred birth. Polly Toynbee, writing in The Guardian, was particularly virulent, dismissing me as a lentil-eating earth goddess…

via Sheila Kitzinger on why feminists HATE natural childbirth and why it’s harmful | Daily Mail Online.

Lentil-eating earth goddesses unite! Unlike Kitzinger’s experiences with the distance between some expressions of feminism and birth-care, I find that many midwives, whether explicitly or implicitly, understand the deep connection between midwifery care, birth activism, and feminism.

“Midwifery work is feminist work. That is to say, midwives recognize that women’s health care has been subordinated to men’s care by a historically male, physician-dominated medical industry. Midwifery values woman-centered care and puts mothers’ needs first. Though not all midwives embrace the word feminism (the term admittedly carries some baggage), I maintain that providing midwifery care is an expression of feminism’s core values (that women are people who have intrinsic rights).

–Jon Lasser, in Diversity & Social Justice in Maternity Care as an Ethical Concern, Midwifery Today, issue 100, Winter 2011/2012

via Midwifery & Feminism | Talk Birth

Perhaps this is because midwives care so deeply about mothers and feminists might actually make the best mothers…

…As a mother who works extensively with other mothers, I appreciated Caron’s acknowledgement that raising children is a feminist act with potential to create change as well. “Another strategy for change is through raising children to be just and caring people. A media image portrays feminists as being against motherhood—but in fact, feminists make the best mothers. They raise children aware of themselves and the world, of options and values, of what justice means and how to work toward it, and how to be self-critical and self-respecting” (p. 203-204). Caron also explains that “in a just society, women would be free to make whatever decisions they needed to, for however long they needed to, in relation to political action in the public and the private sphere. All people would participate in the decision-making, and women would be supported in their decisions rather than, as sometimes happens, made to feel guilty for not doing enough or not valued for what they do.”

via Thesis Tidbits: Feminism, Midwifery, and Motherhood | Talk Birth.

dayofmidwifeHappy International Day of the Midwife! Thank you for bearing witness to our journeys and for holding the space for the continually unfolding spiral of life.

“…As we ready ourselves to accept new life into our hands,
Let us be reminded of our place in the dance of creation.
Let us be protectors of courage.
Let us be observers of beauty.
Let us be guardians of the passage.
Let us be witnesses to the unfolding…”

—Cathy Moore (in Sisters Singing)

via National Midwifery Week! | Talk Birth.

In addition to midwives, we’re also celebrating mothers all week this week! First on our lineup of activities is our gift to you: our first ever coupon code for $5 off purchases over $15. Use code: MOTHER.

We’ve also got a giveaway upcoming, two new product launches, a new Facebook group, and two class announcements! Stay tuned…

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Thursday Tidbits: The Return

1800276_792912184104774_7325239257627050486_nTwo months after Tanner’s birth, I still feel like I’m “coming back” from this trip.

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And, speaking of returning, last night I went back to teaching my in-seat class. I am grateful to have a husband who accompanied me to keep the baby close on site for nursing as well as for helpful parents who rearranged their schedules/lives to take care of our other kids while we were gone.

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At class last night.

As I mentioned in a recent post, I’d mentally prepared to be “off” until January and now that it is January, I have a feeling of being sped up in an unpleasant way. So, I appreciated reading this essay and the reminder: you just had a baby.

You just had a baby.

So, let’s stop pretending like that didn’t just happen.

And let’s give you some grace and permission.

You don’t have to answer every email, every text or every invitation that comes your way. You don’t have to keep your house clean or make fancy dinners this week or plan your family vacation for the year. You don’t have to take your toddler to the dentist or figure out how to save for college right now…

You Just Had a Baby | Ashlee Gadd.

While I do keep up with a large variety of projects, ideas, communication, and relationships, there is not a single day that passes that I don’t drop a ball, forget something, let something go (intentionally or not), or let someone down. There are emails I don’t answer, calls I don’t take, and text messages I don’t respond to as well as laundry I don’t fold and piles of clutter than don’t get put away, not to mention all the blog posts I don’t write. This simply has to be okay. I’ve joked with friends and with Mark that my “word of the year” should actually be “ruthless,” meaning that I must be ruthlessly assessing of how I spend my time, ruthless about cutting out non-essentials. Every day involves a pile of choices and some of them are hard to choose between, or to not choose. I must be ruthless in my discernment—choosing wisely, choosing carefully, choosing mindfully. My real word of the year is “grow,” while at the same time the message I’ve frequently been picking up in moments of synchronicity and surprising overlap is “let go.” So, maybe I’ve actually got a trifecta of words this year!

I already wrote about the breastfeeding brain in a recent past post, but it appears that there are permanent changes to the maternal brain as well:

The artist Sarah Walker once told me that becoming a mother is like discovering the existence of a strange new room in the house where you already live. I always liked Walker’s description because it’s more precise than the shorthand most people use for life with a newborn: Everything changes…

The greatest brain changes occur with a mother’s first child, though it’s not clear whether a mother’s brain ever goes back to what it was like before childbirth, several neurologists told me. And yet brain changes aren’t limited to new moms…

via What Happens to a Woman’s Brain When She Becomes a Mother – The Atlantic.

And, speaking of mothers and their childbearing brains, Childbirth Connection has produced two phenomenal new resources. There is a report by Sarah Buckley on the Hormonal Physiology of Childbearing and a companion booklet for mothers that simplifies the research into a user-friendly booklet on the role of hormones in a healthy birth. Great resources for childbirth educators and doulas.

For more see: Hormonal Physiology of Childbearing | Transforming Maternity Care.

Pregnant birthing mama goddess birth art sculpture (doula, midwife, birth altar, childbirth)

 

Welcoming Tanner Matthias!

“There really was a baby!” –Me, in birth video

IMG_8557As was my pregnancy custom, on October 30th I woke up around 3:00 a.m. with definite contractions. They were spaced about 30 minutes apart, however, and I kept myself awake unnecessarily waiting for them to get bigger or closer together. I finally got up at 4:30 or 5:00 and Mark got up too. As I as I got up, contractions picked up to about three minutes apart. I couldn’t believe I’d “wasted time” by lying down, non-sleeping AND non-laboring! I felt very adrenaline filled and excited. The sense of urgency and “coming soon” was very familiar to Zander’s exceedingly fast labor, whereas my sense of need to call Mom during a contraction and then changing my mind afterward was similar to Lann’s. And, leaning on the kitchen half-wall as an ideal labor position was similar to Alaina’s. There was no slow lead-in here, these were sharp, strong, intense contractions that I already couldn’t talk through. Though they felt big and serious, they were also short in duration. I lit my birth altar candle and since I wanted to have clean, freshly washed hair, I decided to take a shower.

043 044After showering and even blowdrying my hair for cuteness in future pictures, the intensity of the contractions increased again. Mark got to work on filling the pool and heating more water as soon as I got out of the shower and he kept messing with the pool even though I was starting to feel like I needed him (also needed pool, so he wasn’t doing the wrong thing!). I felt sure that this was picking up FAST. We texted Mom and she contacted Robin and Summer (midwife and doula). I felt a weird sensation of time pressure then, looking out window, waiting and not wanting to be observed, waited for, or watched. The pool continued to take a lot of time and attention and was annoying. Plus, the hose popped out when Mark was in the laundry room and flooded the floor. I was saying things like, “this had better be the best thing ever, because right now I hate it!” I couldn’t decide if I should keep standing up or try something else like sit on the birth ball or try the water. It seemed early for water (except during contractions!), so I sat on the ball at which point contractions became HUGE, but, also only 8-10 minutes apart. I was confused and kept trying to figure out what made more sense—smaller, more frequent contractions while standing up, or bigger but far apart on the ball. I was laughing about my indecisiveness and kept saying, “so, tell me what to doooooooo!” (which is actually my most despised thing in labor). I opted to stay on the ball because I felt open there and when standing I felt like I was closing my legs together and tensing up. On the ball, I started humming the Sacred Pregnancy Standing at the Edge song I listened to so often during my pregnancy: standing at the edge…clinging to my innocence…one more tiny step…time is here and now…diving into the unknown. I believe in me, I believe in meee-eeee. I believe in me, I do, I do…

Later, in the pool, I turned on the rest of my Sacred Pregnancy playlist from the CD, which I both liked and didn’t like because I could no longer anchor myself then with the “I believe in me, I do” hum.  I talked and joked and laughed about stuff a lot. And, I would sing little things like: let’s find something else to say and not owie-zooooowie… I do not know how else to say that these were intense, big, powerful contractions. To my memory, they feel like they were the biggest, most painful contractions I’ve ever had—but slooooooowly far apart. The sensation of downward pressure was powerful already during each, but the distance between them very confusing. After back and forthing verbally for some time, I decided to get in the pool: this had BETTER be WORTH IT.

I loved the pool, but I also, intensely, felt like I was on “display” or being watched. I also felt a little isolated or separated and observed, even by my own mom (who, mindfully, went to sit on the couch to give me space). I kept feeling worried and pressured about my midwife and doula getting there any minute, even though we talked in advance about how I mainly needed them for immediate postpartum care and only wanted them to come in at the very end. I had never talked to my mom about specifically when to tell them to actually come though, so I kept thinking they were sitting in the driveway waiting for me (they weren’t, because they were being respectful of what they knew I wanted and needed). As with my other babies, I knew in my heart I wanted to birth alone, but then with immediate postpartum/follow-up care. This is hard to balance and gauge. And, I acknowledge that it isn’t really fair to the midwife either! My birth brain really needs to be alone and unwatched and I knew in the pool that I wanted to push my baby out before anyone else was there.

I took my favorite birth goddess sculpture into the pool with me where she kept me company and floated with me and reassured me until I was pushing and set her outside the tub (ever practical, I didn’t want her to get lost in what I knew would end up as bloody water!).

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If you look close, you can spy the little goddess in my hand.

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Here, I was laughing about feeling like a little toad in a pool.

My mom kept me supplied with food and drinks and occasional encouragement and Mark stayed close, touching me and being present. There was lots of waiting in the pool (I feel like) for those slow but BIG contractions. I got out to pee and finally saw some BLOOD. I always wait and wait for this sign because for me it is the herald of nearly full dilation. I have no blood or any leaking or discharge until I’m only a short distance from pushing out a baby! I shook and shook in the bathroom at this point too, which I think was related to the temperature change from getting out of the warm pool and not transition per se, but it could have been both.

Back to the pool and out one more time to pee (more blood! Yay! Blood is so fun! Really. It is super encouraging for me to see during labor at this point.) I started to weirdly fret about my bladder at this point getting in the way of baby’s head (potentially): this can happen, you know, I told my mom and Mark (even though I was totally peeing and had no signs of bladder being in the way). I could tell baby was moving down and getting close to pushing, but I felt impeded with the amniotic sac intact. I moved to hands and knees in the tub and talked to myself: it’s okay. You’re okay. We’re okay. I can do it. We can do it. You can come out baby. We want you. We want you. (I cried I tiny bit saying this.)

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I like how you can see my friendly little birth altar glowing in the background.

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I turned back over then and kept on smiling…

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One hour before birth.

IMG_8543Some time after this, I started feeling inside after each contraction and could feel a hard lump getting closer and closer every time I had a (now close together) contraction. I didn’t feel sure it was a head though, but that maybe I was somehow feeling my own pubic bone or some other mysterious part of my anatomy never before felt. It felt squishy kind of, though hard underneath. (Duh, because it was an amniotic sac around a baby head, Molly!), so then I imagined I wasn’t fully dilated and was somehow prolapsing my cervix instead of feeling a baby’s head. I think these types of thoughts are one of the hazards of being a birth professional. They are also proof, to me, that no matter what odd or frightening things you think, babies’ heads still move down and come out anyway! At this point, the baby began to have hiccups. He was so low that it basically felt like my anus was hiccupping. I had Mark feel them very low on my belly—just above my pubic bone—and then I laughed and saidthis counts as a fetal heart tones check!

Finally, my water broke at last and I knew he was almost out. Pushing was intense and big and felt huge and hard and long. I became convinced baby weighed ten pounds and was probably not going to come out. I felt like it was taking a long time and a lot of work, but according to Mom and Mark it was about four pushes and date stamps on pictures reveal about 5-6 minutes total of this hard work. I also kept thinking someone else was going to come in. I felt the familiar burning on my front right side and knew I would tear again (labial/clitoral). It felt scary and I looked at my mom and said I was scared (she said, “I know”). I almost pushed through the burn, but then I stopped myself and waited for the next push and then his head was out, along with a bloom of blood in the water which does indicate tearing, but I didn’t get checked for tears (by my specific decision and request) so I don’t know for sure. A minimal follow-up push and his body came out into my hands. He bobbed to the top of the pool and I lifted him out of the water. He cried a little and was already reasonably pink. He was looking around and was a little bit gurgly. I talked to him and kissed his head and told him I loved him: oh my little one, oh my little one. Oh my goodness! Oh my goodness! There really was a baby! Oh, he’s CUTE! I noticed his cord was around his neck and arm and somewhat awkwardly moved it off. It was 10:20, a little over five hours after I got up.

We called my dad to bring the kids back over to see the baby and cut the cord and they arrived a few minutes before Summer and Robin got there.

053 054After Robin and Summer arrived, they helped me out the pool which I was eager to get out of, but had a lot of trouble actually doing, and onto my futon nest on the floor between the pool and bathroom. This is the part I didn’t like. So familiar and so not fun. The weak and wounded transition. But, Summer (doula) reminded me that the warrior moments are in feeling the vulnerability too. Sometimes the warrior is found in showing the vulnerability and needing the help.

After some lying on the futon and waiting for the placenta, I went to the bathroom (still holding baby attached with cord) and the placenta finally came out there (after it was washed, I swallowed a small piece of it). Zander and Alaina cut the cord as they had been waiting to do and then left for playgroup with my friend who was waiting patiently outside to take them. When the placenta was examined, they saw he had a velamentous cord, which is fairly rare and can actually be dangerous and possibly explains my widely spaced contractions (giving baby time he needed).

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The baby’s temperature was low and it took us some time and effort to get him warmed up and that was probably because I was in the water a little long after birth and that is my only regret about this birth. When his temperature was normal, we weighed him and he only came up as 6lbs4oz. He then weighed 7lbs4oz at two days, which means he was really bigger than that at birth. He weighs eight pounds now at a week. So, he weighed something at birth, but the exact amount is unknown! He was 20 inches and had a 14 inch head.

As I laid on my futon and latched baby on for the first time, I realized that in all my planning and fretting and preparing and deadlining, I’d forgotten how very, very much love was possible.

Edited one year later to add that Tanner’s birth video is now available online: Welcoming Tanner Matthias (Home Water Birth Video) – Brigid’s Grove

Tuesday Tidbits: Human Rights and Birth

“It takes force, mighty force, to restrain an instinctual animal in the moment of performing a bodily function, especially birth. Have we successfully used intellectual fear to overpower the instinctual fear of a birthing human, so she will now submit to actions that otherwise would make her bite and kick and run for the hills?”

–Sister Morningstar (in Midwifery Today)

486253_470181139659475_1370955888_nWhen I end my introduction to human services class and then again when I begin my social policy class, I ask my students to consider the above: What would happen if everyone cared? What would happen if our first reaction was compassion? What would happen if we focused on what matters? What would happen if we assumed everyone had inherent worth and value and deserves humane care and compassion?

I have said for a long time that women’s rights in birth represent a human rights issue, so I was very interested to receive word of a Human 10360685_10152979214427627_4161278366266845515_nRights in Childbirth campaign:

Women do not lose their basic human rights once they become pregnant. And yet, across the globe, women’s human rights are compromised and violated around childbirth. Examinations, interventions and procedures that pose risks to both mothers and their babies are routinely performed without informed consent, or through coerced compliance via threats or fear. When women come out of childbirth with post-partum PTSD from disrespect, abuse, or obstetric violence, the goal of a “healthy mother and healthy baby” has not been met.

via Home | Human Rights in Childbirth.

Childbirth IS a women’s rights issue and a reproductive issue:

Childbirth is a women’s rights issue and a reproductive justice issue. The United States maternity system is one of the costliest in the developed world, yet our birth outcomes compare poorly to those of other industrialized nations. Among industrialized countries, we consistently rank last or second to last in perinatal and maternal mortality rates. Moreover, birth is depicted in mainstream media with fear, medical intervention, and crisis…

via Business of Being Born: Classroom Edition | Talk Birth.

But, childbirth is also, quite simply, a human issue:

This is the whole point—women’s rights aren’t about “taking” rights from anyone else OR about demanding “special treatment,” they are important for a HUMANE WORLD for all people. I think it is hilariously awful that “women’s rights” are considered a political issue and that there is a section about “women’s rights” in the “opposing viewpoints” database for my social policy class. As long as women’s rights are considered a political issue or as something about which an opposing viewpoint can be held, rather than as self-evident, we are in continued, desperate need of revolution.

via Women’s Power & Self-Authority | Talk Birth.

Human rights in childbirth include access to the provider of one’s own free choice, so on a related note check out this set of consumer-oriented materials about the midwives model of care offered by collaborative effort of several midwifery organizations and endorsed by several others:

“Normal Healthy Childbirth for Women & Families: What You Need to Know” clearly explains and advocates the benefits of normal, physiologic birth for the average health care consumer. This helpful tool was created from a 2012 consensus statement developed by ACNM, the Midwives Alliance of North America, and the National Association of Certified Professional Midwives.

via OMOT Normal Birth Document Feature Page.

The below quote may seem obvious to birth advocates, but it is revolutionary in terms of health care. When Citizens for Midwifery shared this quote, they noted that, “One the KEY findings of the Lancet Special Series on Midwifery affirms the importance of women and their families participating in planning of health care.” For more from this special series on midwifery, go here: TheLancet.com.

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And, in case we get so caught up in theorizing about appropriate care that we forget the lived experiences of the women who need it, read this tough, sobering article about why “going in pushing” does not a VBAC birth plan make:

Karen’s story is not uncommon and nor is the advice she was given about “going in pushing” but when we tell women they can not be cut unless they consent are we telling the truth? Whilst it’s true that legally the hospital can not physically force you into an operating theatre without your consent, they are not afraid to gain consent using underhand methods…

via Go In Pushing – It’s not a VBAC Birth Plan – Whole Woman.

And, of course, some relevant quotes to remember:

“If women lose the right to say where and how they birth their children, then they will have lost something that is as dear to life as breathing.” –Ami McKay

“Mothers need to know that their care and their choices won’t be compromised by birth politics.” – Jennifer Rosenberg

via As dear as breathing… | Talk Birth.

Is there anything that can be done, or are we facing an insurmountable struggle? I think we can remember that our “small stone” birth activism does matter:

While reading the book The Mother Trip by Ariel Gore, I came across this quote from civil rights activist Alice Walker: “It has become a common feeling, I believe, as we have watched our heroes failing over the years, that our own small stone of activism, which might not seem to measure up to the rugged boulders of heroism we have so admired, is a paltry offering toward the building of an edifice of hope. Many who believe this choose to withhold their offerings out of shame. This is the tragedy of our world.” Ariel adds her own thoughts to this: “Remember: as women, as mothers, we cannot not work. Put aside your ideas that your work should be something different or grander than it is. In each area of your life—in work, art, child-rearing, gardening, friendships, politics, love, and spirituality—do what you can do. That’s enough. Your small stone is enough.”

These quotes caused me to reflect on the myriad methods of “small stone” birth activism that can be engaged in as a passionate birth activist mother embroiled in a season of her life in which the needs of her own young family take precedence over “changing the world”…

via Small Stone Birth Activism | Talk Birth.

And, on a fun note, you might enjoy this lovely homebirth treasury on etsy: Home Birth by Kayleigh on Etsy. 🙂

“Thousands of women today have had their babies born under modern humanitarian conditions–they are the first to disclaim any knowledge of the beauties of childbirth…” –Grantly Dick Read, Childbirth without Fear

“I am not free while any woman is unfree, even when her shackles are very different from my own.” –Audre Lorde

“Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women—half of all people—that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society.” –Marsden Wagner

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Good Birth Books to Gift to Others

I’ve recently had several requests from friends asking about the best birth books to give as gifts to pregnant relatives. After sending my third response, I realized that there’s a blog post in here somewhere!December 2013 010

Here are my current recommendations:

Sacred Pregnancythis book is simply beautiful. My past review is here.

Giving Birth with Confidence—this is the well-known childbirth education organization Lamaze International’s guide to pregnancy and birth and it is one of my favorites. My review of a past edition is here.

The Birth Partnerthis guide by Penny Simkin is a classic for helping fathers or other birth partners serve during labor

The Greatest Pregnancy Everfocused on positive mental attitude during pregnancy and cultivating a mother-baby bond prenatally (caveat: I’ve not actually finished reading this one, so I’m not sure if I have any reservations about it or not. I bought it at the last CAPPA conference)

Birthing from Within—the original birth art resource and a fabulous “out-of-the-box” handbook for preparing for birth. It is not attached to a particular outcome and can help mothers dig deep whether experiencing a home birth or a cesarean. This book is my all-time favorite, but my recommendation comes with a caveat that the short breastfeeding section is terrible.

The Baby Book-a comprehensive, reassuring look at baby’s first year by Dr. and Martha Sears.

For birth stories, I love and adore Simply Give Birth (past mini-review is here). I also like Journey Into Motherhood (available as a free digital copy here) and Adventures in Natural Childbirth.

I used to recommend The Thinking Woman’s Guide to a Better Birth, but is has been replaced by an updated version called Optimal Care in Childbirth and I’ve not yet read that one. My educated guess is that it is still an excellent recommendation! 🙂 I also used to recommend The Birth Book by Dr. Sears. It is still a good suggestion, but it is now an “older” book and so I don’t put it at the top of my list any longer.

Also, make sure you grab a copy of the free Guide to a Healthy Birth from Choices in Childbirth. I love this little booklet so much! It is my top favorite resource for tabling at community events. Another free educational resource that I recommend (particularly for women planning natural births in hospital settings) is Mother’s Advocate. There is a free booklet and a series of videos that explore Lamaze’s Six Healthy Birth Practices (which all mothers deserve as part of evidence-based care during birth, regardless of birth location).

Past book lists and related suggestions:

What To Do When Newly Pregnant and Wanting a Natural Birth…

Suggested Reading

Postpartum Reading List

Book list: Preparing Children for Homebirth

Non-Advice Books for Mothers

2012 Book List (all kinds of stuff, not just birth)

In addition, all the books I’ve reviewed in the past are available on my website from this link, so make sure to browse and see if anything else jumps out at you as a good match.

“Everyone who interacts with a pregnant woman is, in some way, her ‘teacher.’ Telling birth stories, sharing resources, imparting obstetrical information, giving advice or warnings—these are all direct or indirect ways of teaching about birth and parenting. Whether you currently identify yourself as a ‘childbirth teacher,’ or you are a midwife, doctor, doula, yoga teacher, nurse, therapist, breastfeeding counselor, or you are simply a woman or man who cares about the power of the childbearing year, you already hold the power of mentoring within you.”

–Pam England

Guest Post: Squatter’s Rights

October 2013 024

Squatter’s Rights

A couple of posts ago, I mentioned I’d made a new sculpture that I titled after a friend of mine and an article she wrote several years ago. She originally sent me the article to review, because she was thinking of sending it to a magazine. Several years passed, several more babies were born, her computer got fried, and the article was lost. However, it stayed with me anyway. It stayed with me when I prepared for the birth of my rainbow baby girl, it stayed with me as I created birth art to prepare for her birth, and it stayed with me as I reached down to catch my baby’s whole pink wonderful self in my hands as she was born in one smooth reflex almost three years ago. So, I created my figure and I emailed Shauna about it and then I went digging. Deep in the ancient, archived messages in my Outlook Express folder on my old laptop that now belongs to Zander (age 7), I found it. I found Shauna’s squatter’s rights article that had so touched my birth consciousness in such a way that I never forgot—even though babies, computers, friendships, and time have all marched on. I was already a childbirth educator when I read it, had already given birth myself, and was deeply immersed in birth work and childbearing. However, that doesn’t mean that certain descriptions cannot reach us and grab our attention in new ways. I’m delighted that Shauna gave me permission to publish her article here and to share her insights and experiences in this way!

Squatter’s Rights

by Shauna Marie

Would the new child coming from me be slippery like soap? I rubbed my fat belly. I loved each pound I gained, each craving I had, and every trip to the bathroom. Okay, maybe not every trip to the bathroom. But, I loved this growing baby. Tucked away like a pearl in the sea just waiting to be discovered. I was in a constant state of marvel.

Would I be able to physically do this? No, I don’t mean the labor, nor do I mean the birth. I knew I could do that. I got lost in thought as I planned in my head every moment that would come after my body did the work of labor. The moment would come once my body was ready and the crown of a child’s head pushed itself from me, the moment the child would emerge. That’s what I was planning for; I planned to catch my own baby.

I imagined opening my legs and squatting, I even practiced. I wondered where I’d put my hands, how I would have my legs, and if this little wet creature would be so slippery that I’d drop him or her. In December of 1999 this would be my second birth, but my first time catching a baby.

Like many people from a young age I was led to believe that women didn’t and couldn’t birth outside hospitals. The ones who did were radical or even dangerous. I was led to believe that the birth doesn’t matter, the baby matters. For my own personal sanity, due to cultural birth fear, I had to just come to the conclusion that as long as my baby was okay I could endure anything and that it would all be over soon.

Now rewind a little bit here, because there is something to be said about being at the right place at the right time; or knowing the right person. As a person who now tries to make a difference by being a strong home birth and natural family living advocate, I know who you know can sometimes make all the difference. For some people they just need that connection with real birth; they need to know someone who will talk about what birth really is about from a natural and physiological point of view. Above all people need to be exposed to home birth because it normalizes birth.

I was almost connected at one small point during my first pregnancy, just weeks before my first birth a friend of a friend was having a baby. I asked where she was having the baby at and when. My friend said she was in labor now, and having the baby at home. A jolt of sudden uncomfortableness and worry struck me, “At home! Why?” (Thinking oh my gosh there is no epidural at home!) My friend responded with a rather obvious sounding answer, “Well her mom is a midwife.” “Oh,” I said in an understanding tone. Somehow this made total sense now. If her mom is a midwife then it’s okay for her.

Quickly all home birth thoughts were intercepted with other conversations of non-birth related content. To this day I feel that should have been my contact with home birth. Instead I missed my first calling and just two months later I was induced two weeks before my due date against my own wishes (along with two other women from my OB’s office) to fit into the OB’s schedule.

I learned an awful lot that night. I learned I would never give birth to a healthy baby in a hospital again. I learned that in a hospital it is okay for others to look at your body, touch you, reach into you, and deliver your baby; but it’s not okay for you to do so.

I also learned that birth does matter, not just a healthy baby. Healthy empowered moms matter and instincts are stripped away by technology and birth colliding. This often even includes the instinct to breastfeed.

I was shocked at how disconnected I felt from the waist down. These strangers were in charge of me. There is something about being tied to IV’s and monitors, naked from the waist down in a hospital bed, legs in stirrups, that takes your power away. Even though some one at some point said, “Here comes your baby, look at your baby come” I felt like I wanted to reach over my belly and feel, or catch. I’d seen that in a birth video once –a nurse said something like ‘you can touch your baby’s head and feel’ to a mom giving birth flat on her back. I waited for someone to say that to me, but no one did.  Be it because of hospital policy, or be it because of shame, it was a no-no to touch or even catch what was mine. I felt so disconnected as I tried eagerly to see over my belly, knees being held up to my ears by three sets of hands to the chants of, “Push, push, pushhh…. good girl.”

I wondered so much about just staying home. I had what I thought was an unexplainable and unfounded desire to hibernate in a dark corner like an animal.

Around the same time that I got pregnant with baby number two I heard a doctor on television actually say that women are physiologically unable to catch their own babies. Already committed to having a home birth that comment further sealed the deal. I was catching my own baby this time. Not only do I dislike someone telling me that I can’t do something, I didn’t believe a woman would let her baby just fall to the floor (many mammals are born that
way though). Surely even if a woman didn’t squat with intent to catch her baby the child would be born slipping onto bed or floor without assistance or harm. My research lead me to discover that women have given birth effortlessly while in comas, unassisted and unmedicated. We’ve all heard the stories of scared teens giving birth suddenly, alone in a bathroom. The body just gives birth when it’s time. Not to mention National Geographic taught me from a young age more than just that women in tribes go topless; they also sometimes give birth to babies unassisted and catch them.

Shauna’s eighth baby, born into her hands this summer.

I was also somehow sure a woman could give birth in total control; in control of her thoughts, feelings, and use of good judgment. I was no longer buying into the stereotypical out of control agony portrayed in movies. I didn’t know, but I deeply believed a woman giving birth, if allowed, could totally be in control and instinctively know how to give birth.

I figured that squatting would give me the best angle to catch my baby. Being in a squat, on bent knees, or even on all fours is clearly the most natural and easiest way to birth a baby. Squatting has roots in ancient history as far as birth goes back. It is only within the last 100 to 150 years, since physicians took control of birth, that women have been required to have babies laying their backs in the lithotomy position. Lying on the back (or semi lying) has obvious benefits from the doctor’s perspective as it provides a good view and way to manually remove a baby, as well as use a scalpel to cut a wider opening to the vagina. The use of gigantic tongs (forceps), vacuum suction extraction on the baby’s head, and even manually pulling on the baby’s head have all been routinely practiced by physicians.

Elizabeth Noble, author of Childbirth with Insight, states, “Women who squat for birth can generally deliver their babies without any manual assistance at all. Gravity and the free space around the perineum allow the baby’s rotation maneuvers to be accomplished spontaneously.”

There are vast differences in giving birth in a squatting position rather than lying down. Well over half of all the births in this country currently involve some type of surgical or operative procedure such as; cesarean section, episiotomy, vacuum extraction, or the use of forceps. These interventions and their accompanying risks could be avoided if women would just adopt a squatting position for birth. Aside from working with rather than against the body and gravity the birth canal depth is shortened during a squat, and the pelvic diameter is increased. In fact just the simple act of squatting can open a women’s pelvic outlet by up to 28 percent. All of these benefits can shorten the second stage of labor and the need for interventions. Squatting also reduces the risk of tearing. Dr. Michel Odent writes in Birth Reborn that, “This position assures maximum pelvic pressure, optimal muscle relaxation, extensive perineal stretching, and minimal muscular effort. It also provides the best safeguard against serious perineal tears.”

Routinely birthing moms are put on their backs or reclined in beds which center the mother’s weight on her tail bone, narrowing the pelvic outlet and compressing major blood vessels which reduce proper circulatory function. This in turn reduces oxygen to the baby and to the uterus making contractions less productive and more painful. Less oxygen to the baby signals distress in the infant, which if in a hospital could cause a whole round of interventions. Combine an oxygen deprived baby with a mother trying to push uphill with a baby that cannot move into a good birthing position because of restricted pelvic room, and ultimately you have mothers who are very good candidates for a birth that must be forcefully assisted by forceps, vacuum extraction or the ever so common routine C-section. The Centers for Disease control states on their website that cesarean sections are now at 32.8% in North America (2011).

Delivery of the after birth in an upright position also has clear advantages. When the placenta isn’t compressed there is less chance of blood pooling up and creating large clots, and gravity aids in placental expulsion.

When the day finally came for me to catch my baby I talked myself through the contractions. I told myself I could do this. I said over and over I can do this, because as a pregnant mammal it’s what I was put here to do. When I felt it was time I squatted over a mirror and saw the crown. I told myself to enjoy this moment, not everyone gets to catch their own baby, and I didn’t want to miss one second of this experience. I swirled the thick wet black hair that was presenting around in a circle with my fingertips. Any and all pain was gone, it was amazing. I focused on this new life that was unfolding from my body. I waited for contractions and I let my body do the work without forceful pushing or feeling agony. When the baby slid into freedom and the room was engulfed with newborn smells and newborn cries I cried out, “It’s a boy, it’s a baby boy!”

The impact of that birth was powerful and amazing; so much so that I have caught five more children from my body since then. There is a saying about the “thrill of the catch,” and midwives and doctors know this. It’s intoxicating and it’s very powerful to catch a baby.

So much harm has been done to cloud the process of childbirth. Birth isn’t just about babies, it’s about mothers too. It’s about how they work together. Catching your own baby puts you focused on your birth, and without trying you take the control and suddenly you feel and know what you need to do. Focusing on the important task of birth made an impact on me a very positive way as a mother. True freedom over my body gave me independence, confidence, and self-control.

Not every woman may want to catch her own baby, but every woman should be encouraged to do so, or at the very, very least know they can if they do wish to. Most women I have spoken with actually say they have never even thought of it.

The state of birth in this country lies squarely in the hands of birthing women. Until we start demanding more respect and more variation in our birthing options we have no one to blame but ourselves. We must first credit ourselves with being able to birth safely the way nature intended before anyone else will give us that credit. The seeking out of safe and natural birth options will slowly continue to influence and change how birth is perceived.

There are specialized hospital beds that can be converted in a way that women are more upright. If you will be giving birth in a hospital request them, demand them. Hill-Rom makes such a bed; the Affinity Three Birthing Bed aids a woman to side lie, squat, kneel, sit, and lean in various positions. It has a labor bar and position controls that are quite impressive. The bed can be lowered or raised up, down, back, and forth

There are birth balls, birth bars, and birthing stools that can aid in more natural upright positions in whatever birth setting you choose. There are showers and tubs to soothe a mother.

I share my experiences with catching my own babies, and have even shared very private birth photos and even one video with others in the past; because I have been told by so many women it has empowered them. I also hear from lots of women who say how strong both me and my legs must be to squat down like that. I assure that it’s not my legs that are strong; it’s my heart and my passion, and the willingness to open up and catch what is mine.

Shauna Marie is happily married to the man of her dreams. They live in the Midwest where they juggle eight energetic children while homeschooling and developing upon a one acre hobby farm of veggies, fruits, chickens, geese, and the dream of a dairy goat. She blogs about her life at Life with Eight Kids. Shauna is very passionate about family with an emphasis on childbirth and healthy, happy moms and babies.

Postscript: Shauna’s most recent birth story, excerpted below, is an excellent description of a squatting birth!

I was standing there in the still of the labor lull a rush of hormones hit me and the baby’s head slipped fully into the birth canal. I squatted down instinctively. I was then super indecisive: I flip-flopped between on my hands and knees to squatting, then squatting with one leg up and one leg down, then a leg up on the side of the tub, then standing upright, then a squat-stand and finally then back to the other positions all over again. This baby was going to start to seriously crown in a big way and I had no idea where I wanted to be! Having done this so many times I had way too many choices in my head and I knew what they all felt like. Later Ricky told me he got nervous that I was moving around so much in the tub; he was worried I’d slip and fall. I however felt firmly planted like a rock. I told him later I felt like I had sticky gecko pads on my limbs and slipping never crossed my mind.

Our baby was starting to crown as I finally squatted down low with one leg higher than the other (I was out of time to change things up. I’ll just squat and do it the same ‘boring’ highly effective way I always do it I thought lol.) I used some counter pressure on her velvety head to help ease her head out but it wasn’t really needed and a painless contraction inched her head fully out.

via Life With Eight Kids: Beatrice’s Unassisted Birth Story (half hour labor and birth -with extra info on my favorite topics of vernix, cord cutting, and not pushing).

Related Talk Birth resources:

Active Birth in the Hospital

Spontaneous Birth Reflex

How to Use a Hospital Bed without Lying Down

What to Expect When You Go to the Hospital for a Natural Childbirth

References:

(Elizabeth Noble, Childbirth with Insight, 78). See also Golay, J., et al., “The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being,” Birth 20(2) (June 1993):73-78.

Postpartum outcomes in supine delivery by physicians vs nonsupine delivery by midwives.Terry RR, Westcott J, O’Shea L, Kelly F. J Am Osteopath Assoc. 2006 Apr;106(4):199-202. Conclusion: Nonsupline positions during labor and delivery were found to have clinical advantages without risk to mother or infant. Enhanced maternal outcomes included improved perineal integrity, less vulvar edema, and less blood loss.

Dr. Martha Collins D.C., Pregnancy and Chiropractic Planetciropractic.com

Russell JGB. Moulding of the pelvic outlet. J Obstet Gynaec Brit Cwlth 1969;76:817-20

Squatting can enlarge the pelvic outlet up to 28 percent (Russell, J.G., “The rationale of primitive delivery positions,” Br J Obstet Gynaecol 89 (September 1982):712-715

Paciornik M; Commentary: arguments against episiotomy and in favor of squatting for birth. Birth 1990; 17(2): 104-5.

The total U.S. cesarean delivery rate reached a high of 32.9% of all births in 2009, rising 60% from the most recent low of 20.7 in 1996 Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2009. National vital statistics reports; vol 60 no 1. Hyattsville, MD: National Center for Health Statistics. 2011.

Marion Sousa writes: “[Squatting shortens and widens the pelvic outlet.” (Childbirth at Home. New York: Bantam, 1976 in Judith Goldsmith, Childbirth Wisdom from the World’s Oldest Societies, 153)

Several studies have reported that in the majority of women delivering in the lithotomy position, there was a 91% decrease in fetal transcutaneous oxygen saturation (Humphrey et al. 1973, 1974)

Robertson, Empowering Women: Teaching Active Birth in the 90s, (105)

Dr. M. Odent Birth Reborn, (101)

Hill-Rom Affinity Three Birthing Bed educational video and website. Online user manual http://www.hill-rom.com/PDFs/manuals/UserManuals/u025_iet.pdf

Women of Color Can Push for Better Outcomes: What Every Mother-to-Be Should Know About Birth

Guest post by Tara Owens-ShulerImage

As an African American Lamaze Certified Childbirth Educator, I have observed over my 18 years of teaching that childbirth education class participants are less likely to be women of color. My desire for more women of color to attend childbirth education classes is rooted deeper than just their presence in a classroom – it is rooted in my desire for more women of color to understand the disparities that exist in maternal and birth outcomes.

In a recent Science and Sensibility blog post by Christine Morton on maternal health disparities, she reviewed the work of several well-known public health researchers – Dr. Eugene Declercq, Dr. Mary Barger and Dr. Judith Weiss. Their findings point to the fact that African American women have higher rates of cesarean births at nearly every age group and across every level of education.

In addition, the U.S. Department of Health and Human Services reports that one of every five non-Hispanic,black births are pre-term, African American mothers experience an infant mortality rate twice that of non-Hispanic, white mothers, and breastfeeding rates among African American mothers are 16 percent lower than white mothers.

Given the disparities that exist in maternal and birth outcomes for women of color, I think April as Minority Health Awareness Month is a great opportunity to talk about a few other factors that minority moms or mothers-to-be can control or influence. It’s a hard reality that mothers face real challenges in getting the childbirth care they want and deserve. Even though medical evidence may tell us certain practices are good for mothers and babies, the “system” is not always geared to deliver that care. Health care providers are rushed, spread thin, or incentivized for practices that are not most beneficial to the mother.

Let’s go back to the fact that African American women have higher rates of cesarean births than non-Hispanic,white women. Is it because African American women are sicker and need to have a cesarean birth? Researchers report that this is untrue. They conclude that higher rates of cesarean births among African American women are a result of a shift in obstetric practices to focus more heavily on use of childbirth interventions. And, when we bring in an induction to the equation, there is a correlation between the increased rates of induction to the increased rates of cesarean births!

Research shows that babies pay a steep price for these early births caused by inductions or a failed induction, which led to a cesarean. Babies have greater difficulties breathing, breastfeeding, and maintaining their temperature, which usually means being separated from moms and spending time in the Intensive Care Unit. While an increasing number of hospitals and health care professionals are shying away from unnecessary cesarean birth and induction, it’s one of many care practices that just aren’t supported by good medical evidence.

So how can women of color push for better care?

  • Become an active partner with your care provider. While doctors or midwives have professional knowledge and skills, they may not know everything about your personal background and preferences. Finding a provider who will also act as your partner can help you push for the care that’s best for you and your baby.
  • Ask questions – lots of them! Labor and birth in particular can be unpredictable. That’s why it’s a smart idea to prepare a list of rolling questions throughout your pregnancy to help you determine if the right care is being recommended during labor, birth and after birth.
  • Do your research. Understand your available care options before, during and after labor at the hospital or birth center. If you know that during labor you’d like the ability to walk around, eat and drink – choose a birth facility that will be more aligned with your birth preferences or wishes.
  • Participate in a childbirth education class. Taking a Lamaze class will help you understand maternity care best practices and be better prepared to navigate your labor and birth. A childbirth educator will help you identify the right questions to ask when making decisions about your care.

I encourage all women – particularly African American women – to learn more about getting the right care in pregnancy and childbirth by attending a childbirth education class. Skipping out on childbirth education is a lost opportunity to stack the deck in your favor and become a well-informed consumer of evidence-based practices! As a consumer, it is your right to be a partner in your health care decisions.

Tara Owens Shuler, MEd, LCCE, FACCE is the president of Lamaze International. She has practiced as a childbirth educator since 1995. In 2005, she became the Director of the Duke AHEC Lamaze Childbirth Educator Program. In addition to training individuals to become childbirth educators and preparing expectant women and their partners for a safe and healthy birth experience, Tara provides labor support services. Along with coordinating the Lamaze program in the Duke AHEC office, Tara works with her statewide AHEC partners in developing continuing education programs and/or resources for healthcare providers in North Carolina and assists with the Duke AHEC PATHWAYS Health Careers program for K-12 students. When not working, Tara and her husband enjoy playing with their dog, Gramps, and traveling.

Visit Lamaze International for great resources to help mothers and mothers-to-be learn their options.